Medical Licenses Across State Borders 

To meet the high demand for health services without endangering patients, states allowed doctors to practice across state lines during the COVID-19 pandemic [1]. This development was only temporary; since the waning of the pandemic, states have re-imposed prior regulations that only allowed doctors to treat patients present in the state(s) in which they are licensed [1]. Obtaining medical licenses in multiple states is possible and enables cross-border work, but it is more difficult in some states than others. However, the increased capacity and flexibility offered by these pandemic-era solutions reignited an old debate: Should doctors be allowed to practice across state borders? 

State line-based restrictions on medical practice have been in place since the late 1800s [2]. They can be traced to the initially local nature of medical practice: Most doctors could only treat the people living near them, so there was a much lower need for cross-state provision of medical services [3]. However, the advent of telehealth and the expansion of travel possibilities has revolutionized the provision of healthcare services and called into question restrictions on medical licenses and clinical practice based on state borders.  

Proponents of eliminating these restrictions emphasize the increased capacity, flexibility, and efficiency that comes with allowing doctors to practice medicine, irrespective of the state in which their patients are located vs. them. As was made evident by the COVID-19 pandemic, allowing doctors to provide out-of-state patients with telehealth services increased the chances that patients in need would receive the care that they require [4]. This concern is particularly pressing in states facing a shortage of healthcare professionals, such as Nevada and California [5]. Flexible licensing rules not only augment the number of doctors available to treat patients but also boost the chances that patients will be treated by a provider with the expertise needed to tend to their particular conditions [4].

Conversely, so long as restrictions remain in place, only patients with adequate finances and sufficient health to support travel can benefit from out-of-state expertise, creating an unjustified inequality in the provision of healthcare services [6]. 

Doctors could try to expand the scope of their practice by being accredited to practice in multiple states, but this is burdensome. The application process can span weeks, if not months, and requires steep fee payments [1, 7]. Moreover, even once doctors have received a new license, they must keep up with continuing medical education (CME) requirements for the state where they have just been accredited [1]. Ensuring that one complies with multiple CME programs is a demanding pursuit, taking time and resources away from providers who could otherwise be treating patients [1].  

Nevertheless, some actors argue that restrictions should remain in place. In support of this argument, they emphasize the economic interests of states, which generate significant revenue from licensure fees, and some physicians, for whom it is more economically efficient to maintain a localized practice [3]. Others express concerns about disciplinary mechanisms. They worry that cross-state practice would allow practitioners who have been sanctioned in one state to escape such censure by operating in another state [3]. Proponents of relaxed licensure rules counter that cross-state data sharing and the creation of a federal enforcement mechanism could combat this concern [3]. 

Recent years have seen developments such as the Interstate Medical Licensure Compact, which makes it easier for physicians to obtain additional licenses and thus practice across state borders, and antitrust litigation aimed at compelling states to relinquish their control over licensing requirements [1, 2]. Absent federal action, however, the provision of healthcare services in the United States will likely remain constrained by borders. 

References 

[1] J. Appleby, “Telehealth Took Off During the Pandemic. Now, Battles Over State Lines and Licensing Threaten Patients’ Options,” Time, Updated August 26, 2021. [Online]. Available: https://time.com/6092635/telehealth-state-lines-licensing/.   

[2] A. Mehrotra, A. Nimgaonkar, and B. Richman, “Telemedicine and Medical Licensure — Potential Paths for Reform,” The England Journal of Medicine, Updated February 25, 2021. [Online]. Available: https://doi.org/10.1056/NEJMp2031608.    

[3] S. Mullangi, M. Agrawal, and K. Schulman, “The COVID-19 Pandemic—An Opportune Time to Update Medical Licensing,” JAMA Internal Medicine, vol. 181, no. 3, pp. 307-08, January 2021. [Online]. Available: https://doi.org/10.1001/jamainternmed.2020.8710. 

[4] B. G. Carr and N. Gavin, “Interstate Licensure: Has the Time Come?,” HealthAffairs, vol. 41, no. 8, pp. 1133-35, August 2022. [Online]. Available: https://doi.org/10.1377/hlthaff.2022.00774.  

[5] S. Price, “States with the Highest Healthcare Workforce Shortages,” Value Penguin, Updated January 30, 2020. [Online]. Available: https://www.valuepenguin.com/states-highest-healthcare-workforce-shortages. 

[6] E. Wicklund, “Debating the Pros And Cons of Licensure Compacts for Telehealth,” mHealth Intelligence, Updated March 16, 2018. [Online]. Available: https://mhealthintelligence.com/news/debating-the-pros-and-cons-of-licensure-compacts-for-telehealth.  

[7] A. H. Sawalha, “Medical Licensure: It Is Time to Eliminate Practice Borders Within the United States,” The American Journal of Medicine, vol. 133, no. 10, pp. P1120-21, October 2020. [Online]. Available: https://doi.org/10.1016/j.amjmed.2020.04.015.